Professor Hans Rosling, co-founder of the Gapminder Foundation, doctor and professor of international health at the Karolinska Institute in Sweden, presents "Immunisation and Development" at the Plenary Session Partners’ Forum in Dar-es-Salaam, Tanzania. His presentation showed how GAVI’s mission to increase access to immunisation fits into a new way of looking at global poverty and population trends.

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Using his trademark computerised graphs and information diagrams, with circles that swarm, swell and shrink like bacteria under a microscope, Dr Rosling this morning demonstrated that the eligibility criteria for GAVI support is unique in recognising a new world order no longer divided along traditional lines between developing and developed countries.

“I like GAVI because it is intellectually easier to understand why the line (for eligibility) is here,” said Dr Rosling, pointing to one of his trademark graphs.

Drawing on data-visualisation software developed by his Gapminder Foundation, Dr Rosling held his audience spellbound as he plotted country by country economic and public-health data onto two axes: child mortality rates against average national income.

The graph showed that 50 years ago, the world was split into two categories with much of Africa and Asia registering low income and high infant mortality. On average, Africa’s poorest families had six children, of which only four survived.

I like GAVI because it is intellectually easier to understand why the line (for eligibility) is

Hans Rosling

Poor countries shifted closer to richer counterparts

Updating his graph over time, Dr Rosling demonstrated how once poor countries have shifted closer to their richer ‘western’ counterparts. In 2011, places such as Ghana and Tanzania recorded relatively low infant mortality and higher income with the likes of Somalia and Afghanistan at the other “extreme end of the spectrum”.

Superimposing the average national income figure of US$ 1,500 that is the cut-off point for GAVI support on to the graph, it was clear that countries above the line corresponded to the high infant mortality rates traditionally associated with developing countries.

“How did GAVI become clever to have this line at US$ 1,500,” asked Dr Rosling. “Most of what you still call the developing world is already here (low infant mortality). Sub-Saharan Africa have come in late, but they have moved a lot although there is lots of internal diversity.”

Hans Rosling slide

In contrast, OECD’s definition of poverty (US$ 12,000) suggests that more than half the world require aid, even when they have relatively low child mortality with two child families and are not eligible for GAVI support.

For Dr Rosling, the correlation between his graphics and GAVI’s eligibility criteria represents confirmation that it no longer makes sense to consider the world as divided between developing and developed countries. The majority of people are living in the middle—although the distance from the very poorest to very richest is wider than ever.

A new term for the developing world: ‘the world’

“I suggest a new term for the developing world, more intellectually relevant, I suggest we call it ‘the world’,” said Dr Rosling, tongue firmly in cheek. “It’s a problem dividing the world in two groups. It’s like when you drive and you have a rearview mirror and a windscreen. It’s important to use the rearview mirror, but don’t look back all the time. We must be fact-based.

“Almost all (countries with high) child deaths are above the GAVI line. They die because they come from big families, with lots of children. It is interlinked,” he said, “the most common criticism of immunisation is that if you provide life-saving vaccines, you will destroy the planet with population growth. It is untrue. The best route to small families is to make children survive. “

Statistics bear out Dr Rosling’s conviction that there is a linear relationship between money and child mortality. The poorest countries clearly stood out on their own onthe graph with an average family size of six and the fastest population growth.

“This is a sign that we have not completed the job. What we need is that this last group should join the rest,” he said.

Dr Rosling left an audience clearly mesmerised with his solid stats and colourful graphics with an intriguing question. “We need to apply your system throughout the world, not just to immunisation,” he said, “Do we need a global alliance for family planning, can your mechanisms be reproduced in oncology?”

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